If you tick Yes, a member of our support team will contact you to discuss
support services in the College including the bursary scheme.

National Insurance Number:

House Number and Street: *

Home Address Line 2:

City / Town: *

County: *

Home Post Code: *

Telephone Number: *

Mobile Number:

Your Email: *

Date of birth *

Day

Month

Year

Employer details:

Do you have an employer for your apprenticeship?

YesNo

If you have an employer, please give details below:

Company name: *

Company address Line 1: *

Company address Line 2:

Company address Line 3:

Company address Line 4:

Company address Post Code: *

Company contact telephone: *

Company contact email address:

Your Nationality - this section must be completed:

What is your Nationality ?

What is your Country of Residence?

Have you lived in the UK or EEA for more then 3 years ?

YesNo

Are there any immigration restrictions on how long you stay in the UK ?

YesNo

Your Ethnic Origin:

ArabAsian/Asian British - Any other Asian backgroundAsian/Asian British - BangladeshiAsian/Asian British - ChineseAsian/Asian British - IndianAsian/Asian British - PakistaniBlack/Black British - AfricanBlack/Black British - Any other Black backgroundBlack/Black British - CaribbeanMixed/Multiple ethnic group - OtherMixed/Multiple ethnic group - White and AsianMixed/Multiple ethnic group - White and Black AfricanMixed/Multiple ethnic group - White and Black CaribbeanNot Known/ProvidedOtherWhite - Any other White backgroundWhite - BritishWhite - Gypsy or Irish TravellerWhite - Irish

Support for your Course:

Please can you let us know if you have an Education Health Care Plan (EHC):

YesNo

Do you have a learning difficulty or disability?

YesNo

Criminal Convictions:

Applicants for courses which involve working with children or vulnerable adults are required to comply with
the Disclosure and Barring procedures.

Do you have any unspent criminal convictions ?

YesNo

Your Education:

Are you currently on, or have you previously attended a full-time course at Wiltshire College?

YesNo

Are you an apprentice looking to progress onto the next apprenticeship level?

YesNo

Enter the name of your current / last school or college:

Please let us know what qualifications you currently hold or hope to achieve by the time you start college.

It is important that if you are taking exams this year we have your predicted grades.

OR:

I am not currently studying and do not hold any qualifications.

Data Protection:

Consent to process statement.
The Data Protection Act 1998 requires us to gain your consent before we can process any information
contained on this form. Please agree to the ‘Consent to process’ statement below. We regret that without
agreeing we are unable to offer you a course place at this College, and may withdraw any offer already made.

Consent to process statement:
I confirm that the information I have provided in this form is accurate and agree to Wiltshire College
processing personal data contained in this form for any purposes connected with my studies, or with my
health and safety whilst on College premises, or for any other legitimate purpose.